Prevalence of Thin-Cap Fibroatheroma in Relation to the Severity of Anatomical and Physiological Stenosis

• Published in: Circulation Journal Vol. 81; no. 12; pp. 1816 - 1823
• Main Authors: Usui, Eisuke, Yonetsu, Taishi, Murai, Tadashi, Kanaji, Yoshihisa, Matsuda, Junji, Hoshino, Masahiro, Araki, Makoto, Niida, Takayuki, Hada, Masahiro, Ichijyo, Sadamitsu, Hamaya, Rikuta, Kanno, Yoshinori, Lee, Tetsumin, Isobe, Mitsuaki, Kakuta, Tsunekazu
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2017
• Subjects: Coronary angiography; Coronary artery disease; Fractional flow reserve; Optical coherence tomography; Thin-cap fibroatheroma; Coronary angiography; Optical coherence tomography; Thin-cap fibroatheroma; Coronary artery disease; Fractional flow reserve
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-17-0122

Background:The relationship between the features of morphologically unstable plaque and physiological lesion severity remains elusive. We aimed to investigate this relationship using optical coherence tomography (OCT)-derived high-risk plaque characteristics and fractional flow reserve (FFR) as the degree of anatomical and physiological stenosis severity.Methods and Results:We investigated 286 de novo intermediate and severe coronary lesions in 248 patients who underwent OCT and FFR examinations. Lesions were divided into tertiles based on either FFR or quantitative coronary angiographic diameter stenosis (QCA-%DS). The OCT findings were compared among the tertiles of FFR and QCA-%DS. FFR and QCA tertiles were defined as follows: FFR-T1 (FFR <0.74), FFR-T2 (0.74≤FFR≤0.81), and FFR-T3 (FFR >0.81); and QCA-T1 (%DS ≥61%), QCA-T2 (51%≤%DS<61%), and QCA-T3 (%DS <51%). The prevalence of thin-cap fibroatheroma (TCFA) was significantly greater in FFR-T1 (20.0%) than in FFR-T2 and FFR-T3 (7.0%, P=0.03 and 7.7%, P=0.04, respectively), although no significant differences were observed among the QCA tertiles.Conclusions:Physiological severity of coronary stenosis evaluated by FFR correlated with plaque instability in terms of TCFA. Preferable clinical outcomes for lesions with negative FFR based on the existing clinical evidence might be attributable to less likelihood of TCFA.